Healthcare Provider Details

I. General information

NPI: 1477550457
Provider Name (Legal Business Name): JOHN JOSEPH HANNA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 NORTHEAST PKWY
MATTHEWS NC
28105-3742
US

IV. Provider business mailing address

9808 NORTHEAST PKWY
MATTHEWS NC
28105-3742
US

V. Phone/Fax

Practice location:
  • Phone: 704-845-0699
  • Fax: 704-841-1808
Mailing address:
  • Phone: 704-845-0699
  • Fax: 704-841-1808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1709
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: